Healthcare Provider Details

I. General information

NPI: 1114330214
Provider Name (Legal Business Name): M. MELINDA MCMAHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 JACKSON ST SW
CAMDEN AR
71701-3941
US

IV. Provider business mailing address

715 N COLLEGE AVE
EL DORADO AR
71730-4403
US

V. Phone/Fax

Practice location:
  • Phone: 870-836-5743
  • Fax:
Mailing address:
  • Phone: 870-864-2417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2009079
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA1510143
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: